Impact of complete vs partial endoscopic healing on long-term outcomes in Crohn's disease: a prospective multicenter study.

Abstract

Introduction: The STRIDE II guidelines recognize endoscopic healing (EH), defined by an SES-CD score ≤ 2, as one of the main therapeutic targets in Crohn's disease (CD). Nevertheless, complete EH could further reduce the risk of long-term complications in CD. We aimed to assess the risk of long-term complications in CD according to the degree of EH achieved.

Method: We conducted a prospective multicenter study including all patients with EH assessment (2019-2022) in 3 centers and compared the outcomes of patients with complete EH (CDEIS = 0) vs partial EH (CDEIS > 0 but < 4). The primary endpoint was therapeutic failure (need for drug intensification and/or corticosteroid initiation and/or CD-related hospitalization and/or intestinal resection and/or development of a luminal stricture/fistula and/or perianal CD).

Results: In total, 128 patients were included. Patients had been on treatment for a median of 12 months (8.3-24.3) before colonoscopy. After a median follow-up of 22 months (interquartile range, 19-23), 40 (31%) patients experienced therapeutic failure. The risk of therapeutic failure was significantly higher among patients with partial EH (25% vs 43%, P = .036). The risk of CD-related hospitalization was significantly higher for patients with partial EH (2.5% vs 17%, P = .005; hazard ratio = 6.89, Interval confidence 95% (IC95%) = [1.46-32.4], P = .015). The risk of intestinal resection, steroid initiation, and drug intensification among patients with complete and partial EH, were 0% vs 4.3% (P = .13), 2.5% vs 11% (P = .1); and 22% vs 36% (P = .088), respectively.

Conclusion: Although higher-powered studies are needed to confirm these findings, current results suggest that complete EH may be associated with more favorable long-term outcomes than partial EH in patients with CD.